Certified Medical Assistant Practice Exam

When more than one policy pays on a claim, it is called

1. Coordination of benefits

2. Family healthcare rule

3. Split payment system

4. Joint insurance coverage

The correct answer is: Coordination of benefits

The concept of coordination of benefits refers to the process used when multiple insurance policies are in place to manage claims effectively. This ensures that the total benefits paid do not exceed the actual expenses incurred, thereby preventing overpayment. In this context, the primary aim is to determine which policy pays first, taking into account the specific rules each insurer has regarding payment responsibility. The other terms, while related to healthcare insurance, do not define this particular process. For instance, the family healthcare rule pertains to policies covering families rather than addressing how multiple insurance benefits coordinate. A split payment system generally refers to processing payments in parts but does not encapsulate the overall coordination between multiple insurers. Joint insurance coverage simply indicates the presence of multiple policies but lacks the nuanced management of claims that coordination of benefits entails.